Abstract
This article investigates how local political context—including civil society and political parties—influences the development of migrant care worker policies in Taiwan. This is particularly important in a national context where the government has actively utilized migrant care worker policies to solve the crisis in the social welfare sector. This article draws upon documentary analysis of policy debates on the proposed implementation of Long-Term Care Insurance and in-depth interviews with government officials, public service providers and non-governmental organizations to explore how the political alliances of political parties, social organizations, and interest groups affect policy outcomes. While current research focuses on the relationship between social welfare policies and the employment of migrant care workers, this article highlights the local political context and explores how political alliances have influenced the development of migrant care worker policies. This article argues that institutional path dependency and the strong policy alliance between the progressive party and social welfare organizations have stymied changes in migrant care worker policies and prevented Taiwan from further socializing the eldercare sector.
Introduction
Similar to many industrialized countries around the world, Taiwan is facing rapid demographic changes—including greater longevity, declining fertility rates, and an aging population—that create unprecedented challenges in care provision. These challenges are exacerbated by increasing female participation in the labor market and changes in the family structure. These demographic and labor market changes are important because Taiwan—similar to other East Asian countries—is characterized by strong familialistic welfare regimes with little or no publicly provided or market-based care services (Michel and Peng, 2012). As the responsibility for care provision has shifted from the family to the market, this shift has created a greater demand for migrant care workers to fill the care deficit in society. Taiwan started to recruit care labor from abroad in 1992 to meet the high demand for care workers as part of broader efforts to develop the social welfare sector. In short, the Taiwanese government has actively utilized migrant care worker policies to solve the crisis in the social welfare sector. This article explores how the local political context—including civil society and political parties—influences the development of eldercare and migrant care worker policies in Taiwan.
Taiwan: A Deviation?
East Asian countries are characterized by strong developmental states that have emphasized state-driven economic development since the 1950s (Deyo, 1992; Johnson, 1987). Scholars point out that authoritative governments and bureaucrats have been key actors in the formation of welfare states that have been heavily affected by the imperatives of nation building and political legitimation (Gough, 2004; Tang, 2000).
Since the 1990s, the democratic transitions have facilitated the expansion of welfare states in East Asia (Wong, 2004). Over the decades, these states have become more inclusionary than they were during the previous decades by providing extended social policy protection (Peng and Wong, 2008). According to Peng and Wong (2010: 659), Japan, Taiwan, and South Korea have developed an “inclusive social insurance model” with a high level of public support for social equity and more redistributive social insurance policies, such as universal health insurance and senior pension schemes. In contrast, the social policies of Singapore, Hong Kong, and China are driven by a rather “individualist and market-based model,” characterized by individualized social protection through incentivized private savings, due to the absence of democracy, the state’s minimal fiscal capacity to increase social protection, and the lack of public support for solidaristic redistributive social policies.
While sharing similarities with Japan and South Korea, however, Taiwan’s model deviates on social care policies, particularly on eldercare arrangements. It thus poses an interesting empirical puzzle. While both Japan and South Korea have implemented Long-Term Care Insurance as an extension of their universal healthcare insurances in 2000 and 2008, respectively, the Taiwanese government has delayed the implementation of its Long-Term Care Insurance (LTCI) despite President Ma Ying-Jeou’s prioritization of this item on the policy agenda since 2007.
This deviation is also manifested in the migrant care worker policies for eldercare. As Lan (2006: 36) points out, instead of adopting immigration policies similar to those of Japan and South Korea, the Taiwanese government copied the migrant care worker policies of Singapore and Hong Kong. In other words, despite having a similar type of social welfare regime, Taiwan deviated from the inclusive social insurance model of Japan and South Korea and adopted migrant care worker policies resembling those of Singapore and Hong Kong that have drastically different social welfare regimes (i.e., individualist and market-based model).
This article investigates why Taiwan’s model differs from Japan’s and South Korea’s inclusive social insurance model and develops a different pattern of employing migrant care workers. It also explores why the implementation of LTCI in Taiwan has been unexpectedly delayed despite the government’s prioritization of this item on the policy agenda. This article argues that the pre-existing policies had fostered strong policy advocacy communities that created path dependency and resisted policy changes. The data used in this article draw from the author’s fieldwork in Taiwan from August to December 2014 and follow-up research from November to December 2015. This article uses a documentary analysis of political debates and policy changes in immigration policies, as well as 25 in-depth interviews with government officials, public service providers, and non-governmental organizations (NGOs).
Welfare State and Migrant Care Workers
Over the past two decades, scholars have focused on the way that the welfare state organizes the care sector and how social care policies influence the employment of migrant care workers. Empirical studies show that the lack of public provision of social care services has resulted in the increasing recruitment of private migrant care workers in Southern and Continental European countries (Bettio et al., 2006; Da Roit and Weicht, 2013; Williams and Gavanas, 2008). For example, the presence of migrant female workers in the domestic sphere in Italy is a consequence of both the Italian women’s increased presence in the labor market and the absence of an Italian welfare model that provides state-supported care services. Thus, Bettio et al. (2006: 272) argue that the increasing employment of migrant women in home-based care work has marked a shift from the family care model to the “migrant-in-the family” model in Southern European countries.
In addition to the migrant-in-the family model, there has been an increase in the hiring of migrant care workers in care institutions across Europe. Scholars find that in countries characterized by substantial public or private care service provision, migrant care workers are more likely to be found in the formal care sector than in informal household employment (Cangiano and Shutes, 2010; Da Roit and Weicht, 2013). For example, in the UK, the migrant population is responsible for much of the care work performed in the institutionalized setting rather than in households (Cangiano and Shutes, 2010). Studies in the Netherlands show the importance of migrant workers in the delivery of institutional care (Rostgaard et al., 2011; The, 2008). Since these migrant care workers are more commonly employed by private institutional care providers through recruitment agencies, scholars categorize this as the “migrant-in-the-private-sector” or the “agency-based employment” model (Simonazzi, 2009; Van Hooren, 2012).
In contrast, if the welfare state provides more extensive public provision or financing of care services, it will eventually eliminate the demand for migrant care workers in either institutional care service or individual households. For instance, Williams and Gavanas (2008) argue that the low use of migrant childcare workers in Sweden is primarily because of the abundant public provision of childcare services as opposed to eldercare. In sum, the cited studies have shown that different types of welfare states and their care arrangements determine the types of employment of migrant care workers in European countries.
Along the same line, Van Hooren (2012) employs Esping-Anderson’s regime typology and argues that a familialistic welfare state induces a migrant-in-the-family model of care, while a liberal welfare state leads to a migrant-in-the-market or agency-based employment model, where migrant care workers are employed by private care organizations through agency contracts. A social democratic welfare state also creates a limited demand for migrant care workers.
While this literature provides important insights into the ways in which social welfare regime types affect the employment of migrant care workers, it falls short in providing an adequate explanation for why Taiwan deviates from its inclusive social insurance welfare model counterparts and develops a migrant-in-the-family model for eldercare. Therefore, this article adds to this line of inquiry and looks beyond the set of social welfare policies as the sole explanation for variations in the employment of migrant care workers. This article argues that institutional path dependency and political alliances of political parties, social organizations and interest groups have influenced the development of eldercare policies and the employment of migrant care workers. Taiwan provides an excellent vantage point for such an inquiry because of its distinct combination of inclusive social insurance welfare regime and migrant-in-the-family model. In short, Taiwan’s exceptional context provides a good case to study the political aspect of its migrant care worker policies.
Migrant Care Worker Policies in Taiwan
Taiwan started to recruit live-in caregivers as the government legalized temporary guest worker programs in the early 1990s. Because of increasing production costs and Taiwan’s declining competitiveness in the global market, its local businesses and industries began lobbying for the legalization of importing foreign labor in the 1980s. In October 1989, the Taiwanese government began officially recruiting foreign workers for public national construction projects, such as highways and the metro system in Kaohsiung. In May 1992, the legislature passed the Employment Service Act, which served as a legal basis for the recruitment and the regulation of foreign workers (Lan, 2006).
Five months after the passage of the Employment Service Act, the Taiwanese government expanded migrant workers’ work permits to private industries and started to grant work permits to families and care institutions to hire foreign domestic helpers for households with children under the age of 12 and elderly members above the age of 70, as well as migrant workers employed as live-in caregivers to care for the frail elderly and people with severe illnesses or disabilities, upon their doctors’ recommendations. For foreign domestic helpers, the Employment Service Act stipulates that to be eligible, a family should have at least three dependents living in a single household (for instance, a family with triplets under the age of two or a household with two children under the age of two and one grandparent over 90 years old). A regular working family with one or two children is not qualified to hire a domestic helper. In other words, unless a family can prove its “excessive need” for outsourcing care, the Taiwanese government still assumes that it is family’s role to provide care.
In addition to the excessive care requirements, the Taiwanese government imposes a strict quota, capping the total number of foreign domestic helpers at 2000. From the Taiwanese government’s perspective, having a “foreign nanny” at home should never become a norm for Taiwanese families. As an official from the Council of Labor Affairs (now the Ministry of Labor) clearly expresses, “Foreign maids could help take care of the elderly, but we still hope that children can be taken care of by mothers, rather than leaving them to foreigners” (Lan, 2006: 36).
On the other hand, the Taiwanese government created another live-in caregiver category 1 to accommodate the need for 24-hour intensive care for the sick, the elderly, and people with disabilities. Compared with the restrictive quota and the point system for foreign domestic helpers, the employment of a live-in caregiver requires an official evaluation and recommendation from a doctor in a public hospital, who can verify that the patient or the elderly person is unable to perform day-to-day activities independently. In the beginning, the live-in caregiver program was open to all families who had long-term care needs related to aging and disabilities. As the number of applications rapidly increased, in 2000, the Ministry of Labor adopted the Barthel index 2 for a doctor’s evaluation to avoid fraud and overuse. So far, there has been no quota control for the live-in caregiver category. Rather, the Taiwanese government has gradually relaxed the requirements and made it much easier to hire live-in caregivers for eldercare at home. The requirements have changed from severe to mild disabilities 3 for the elderly between the ages of 80 and 84 and to slight disabilities 4 for the elderly over the age of 85.
Additionally, the live-in caregiver application is open to care institutions, such as eldercare centers and nursing homes. These care institutions can apply for migrant live-in caregivers, according to the numbers of patients they accept in the facilities, but the total number of migrant workers should be less than that of local Taiwanese workers. The care institutions are required to provide food and lodging to migrant care workers. Migrant care workers employed in the care institutions are under the legal protection of the Labor Standard Act as local workers—with stipulated minimum wages, work hours, weekly days off, and health insurance. This is the only group of migrant care workers that is protected under the Labor Standard Act, while both foreign domestic helpers and household live-in caregivers are excluded.
While the Employment Service Act stipulates that migrant workers in Taiwan are entitled to equal rights and protection as local workers, migrants working in individual households are excluded from such rights and protection. The Taiwanese government attributes the difficulties in regulating domestic care work to the live-in requirements and the private nature of individual households. In other words, although the Labor Standard Act protects the rights of the majority of migrant workers, the government intentionally leaves the treatment of live-in caregivers and domestic helpers open for negotiation. Contract negotiations among migrants, brokers, and employers also contribute to precarious working conditions due to the power asymmetry between employers and migrant care workers.
Currently, most of the migrant care workers receive a monthly minimum wage of NT$15,840 (US$528) per month, which has remained the same for the past 22 years despite inflation. 5 For migrant care workers entering Taiwan after September 2015, their salary has been increased to NT$17,000 (US$567) per month, under the diplomatic pressure of the sending countries (Indonesia and the Philippines). However, it is still significantly lower than the stipulated minimum wage of NT$22,000 (US$734) in Taiwan (see Table 1).
Types of migrant care workers in Taiwan.
Source: Author’s collation from the Ministry of Labor (ROC) policy documents.
The Taiwanese government has currently stopped releasing quotas for the employment of foreign domestic helpers but imposes no quota restriction on the employment of live-in caregivers. Many families that need help in care responsibilities often apply through the Live-In Caregiver Program (sometimes with forged documents) to avoid long wait times (Lan, 2006). Thus, the number of migrant care workers—mostly as eldercare workers—entering Taiwan each year has increased significantly. As of February 2017, approximately 240,000 migrant care workers are employed in Taiwan, and this group has become a vital workforce for the welfare sector in Taiwanese society (Ministry of Labor, 2017).
Tracing the Changes in the Migrant Care Worker Policies
When the Live-in Caregiver programs were first introduced in 1992, the quota for foreign domestic helpers (for childcare, eldercare, and household chores) was set much higher, with less restrictive requirements. The Council of Labor Affairs (now the Ministry of Labor) set 8000 workers as the quota, with the following requirements for eligible families: (1) dual-income families with children under 12 years old, (2) living with a parent or parents over 70 years old, (3) living with a parent-in-law or parents-in-law over 70 years old, and (4) seniors living alone (Ministry of Labor, 2014). To accommodate the high volume of applications, the Council of Labor Affairs released another quota of 8000 workers in 1995 and introduced the point system to prioritize families with more urgent care needs. Due to the popular demand, the Council of Labor Affairs restricted the requirements to children under six years old and seniors over 75 years old. In 1997, approximately 12,879 foreign domestic helpers (the only category for childcare and household chores) and 26,233 live-in caregivers (for seniors and people with disabilities) worked in Taiwan (see Table 2).
Number of migrant care workers in Taiwan, 1992–2017.
Source: Ministry of Labor, Taiwan, ROC.
However, middle-aged Taiwanese women who worked in childcare as a part-time job to subsidize their income strongly opposed the recruitment of foreign domestic helpers. Under such pressure, the Taiwanese government became increasingly restrictive with this category and increased the requirement to a minimum of 16 points in 2001 (Interview with Ministry of Labor, Nov. 2014). In April 2013, the Taiwanese government reduced the total quota to 2000 workers and promised to gradually stop this program as the current workers’ contracts expire.
In contrast, the live-in caregiver program expanded during its first two decades, without much opposition from local care workers, largely because the eldercare market was less developed than the childcare market in the 1990s. Taiwan’s senior population was around 7% in 1993 before the rapid rise in its aging population. The Taiwanese government framed the live-in caregiver program as a necessary aid for families with seniors and people with severe disabilities to cope with daily activities, which had better policy appeal and earned public support (Chen, 2011). As caring for seniors and people with disabilities was regarded as a less attractive option for local Taiwanese care workers, recruiting labor from abroad did not induce opposition from local care workers. 6 Rather, it was understood as an important alternative to family care, which alleviated the burden of the affected Taiwanese families.
Through the years, easy access to foreign caregivers has made the Taiwanese government more reluctant to develop its public provision of long-term care services. Taiwan maintains its strong familialistic care regime, which relies heavily on individual families and migrant care workers (as substitutes for family caregivers) to provide long-term care. According to a recent survey, among 760,000 long-term care recipients, only 12% are supported by the government’s long-term care services, while family members account for 59% and migrant care workers provide 30% of care provision (Chen, 2016). The reason is that families hiring migrant care workers are excluded from accessing government-provided care services, such as daycare centers and respite services, which in turn increases the families’ reliance on migrant workers. Over 60% of patients with severe disabilities and seniors with dementia rely on migrant care workers for their intensive care needs (Liu, 2015). In other words, as care work becomes more intensive and demanding, it is more likely to be outsourced to migrant care workers. Thus, the Taiwanese welfare state maintains its familialistic model alongside a “migrant-in-the-family” model (Bettio et al., 2006).
Development of Taiwan’s Long-Term Care
Taiwan’s “migrant-in-the-family” model is also influenced by the stymied development of long-term care policies. Taiwan first implemented the Senior Citizens Welfare Act in 1980 to provide the legal basis for the regulation of eldercare facilities (mostly non-profit organizations), with little intention to intervene in service provisions. It was not until March 2000 that the Ministry of the Interior launched the Long-Term Care System Development Pilot Project, which aimed at developing a long-term service delivery model in selected cities, such as Chaiyi and Sanying (Chyn, 2013).
Soon after the launch of the pilot project, the Democratic Progressive Party (DPP), the main grassroots opposition party since the authoritarian period, was elected for the first time in May 2000. The unemployment rate suddenly increased from 2.99% in 2000 to 4.57% in 2001 and then, to 5.17% in 2002. The public blamed the DPP’s inexperience and inability to govern and questioned whether the DPP government could stimulate economic growth. To respond to these criticisms, the Council of Economic Planning and Development (CEPD) under the Executive Yuan (cabinet) proposed the Care Service Industry Development Project in 2003, which aimed at developing the local care market while channeling local unemployed workers into the care service sector. The DPP government believed that this project could solve the problem of unemployment and, at the same time, respond to the concerns of the aging population (Lin, 2010).
The goal of the Care Service Industry Development Project was not the government’s active involvement in care provision but deregulation of the care market and the lowering of the barriers to attract local investments and workers in the care industry. Through the deregulation and marketization of eldercare service, the CEPD aimed to expand the coverage of care recipients without increasing the government’s fiscal burden. The market competition would encourage service providers to improve the quality of care services. The CEPD contended that deregulation would increase market options for families with care needs, which in turn would reduce their reliance on migrant care labor and allow the local workforce to enter the care market (Lin, 2010).
The primary challenge of the Care Service Industry Development Project was to modify the Senior Citizens Welfare Act, which, at that time, only allowed non-profit organizations and small for-profit organizations (with less than 50 patients/beds) to provide eldercare services. To deregulate the eldercare market, the Care Service Industry Development Project required the government to relax the restrictions and lower the entry barriers to attract local investors to participate in the care industry. As the Executive Yuan organized the inter-ministry discussions regarding the law modifications, social welfare groups and non-profit organizations, which had been cooperating with local governments in providing long-term care services, pressured the Ministry of the Interior to oppose the marketization proposal (Interview with NGO, Dec. 2014). On the other hand, the CEPD had difficulty in attracting local investments to support the project due to the uncertainty of the local long-term care market. Thus, the marketization proposal was halted, and the eldercare service sector remained limited to non-profit organizations and small for-profit organizations.
In April 2005, to push for the development of the long-term care system, a minister without a portfolio, Fu Li-Yeh, initiated the Long-Term Care System Planning Small Group, which was the inter-ministry policy planning committee for Taiwan’s long-term care. After years of planning, the government introduced its Ten-Year Long-Term Care Plan in 2007, which was the first official plan for the national long-term care service system. The ruling DPP government planned on spending NT$81.7 billion (US$2.7 billion) over the 10-year period (2007–2016) to build the infrastructure for the long-term care service system (Lin, 2010).
Policy Debates on Long-Term Care Insurance
By the time the Ten-Year Long-Term Care Plan was launched in 2007, Taiwan also entered its presidential election campaign season, and long-term care quickly became the center of the policy debates. To compete against the incumbent DPP government, Kuomintang’s (the KMT or the Chinese Nationalist Party) presidential candidate Ma Ying-Jeou proposed a social insurance approach to implementing the LTCI as an extension of the National Health Insurance, following the experiences of Japan where Long-Term Care Insurance was introduced in 2000 after the Golden Plan. The DPP’s presidential candidate Frank Hsieh proposed continuing the existing tax-based Ten-Year Plan as it was just introduced. The two major political parties had presented two distinct proposals regarding the long-term care system. While the KMT proposed the social insurance approach to implementing the LTCI, similar to those of Japan and Germany, the DPP preferred the existing tax-based social welfare programs, similar to those of the Nordic countries. This policy divergence appeared to be the center of the debate during the 2007 presidential campaign.
However, after Ma was elected, his LTCI proposal faced strong opposition from the social groups and the legislature. The main criticism was that the Ten-Year Plan was implemented only in the previous year (2007) and had not developed enough infrastructure to deliver care services for the proposed LTCI. Moreover, the regional disparities between urban and rural areas made many care services unavailable in rural areas, where the percentage of the aged population was much higher than in the cities (Interview with Ministry of Health and Welfare, Nov. 2014). Critics contended that it would be unrealistic to ask enrollees to pay LTCI premiums with limited or no service available in their areas. The Federation for the Welfare of the Elderly and the League for Persons with Disabilities argued that with limited infrastructures of public care services, the LTCI would incentivize for-profit corporations to enter the care industry, which would lead to further marketization of long-term care services. Feminist groups also criticized the government’s LTCI draft for excluding families that hire migrant care workers from using the long-term care service. Moreover, Taiwan’s Industry and Commerce Association, representing the interests of Taiwanese business employers, also rejected the government’s LTCI proposal, which required the employers to pay 60% of the premium for each employee (Interview with NGO, Dec. 2014).
To respond to the strong opposition, Premier Liu Chao-Shiuan decided to temporarily postpone the LTCI proposal and continued the existing Ten-Year Plan. Instead, the Ministry of Health and Welfare drafted the Long-Term Care Service Act (LTCSA) to provide integrated and comprehensive regulations for long-term care institutions—including nursing homes, residential care centers, daycare centers, and care centers for persons with disabilities. The LTCSA requires the official registration of both Taiwanese home caregivers and migrant care workers and makes job training available for both local and migrant care workers. At the same time, the LTCSA allows home care or community care centers to hire migrant care workers for dispatch to home care services.
When the LTCSA was sent to the legislature for review in 2011, it was subjected to heated political debates. While the act itself only includes regulations for care institutions, without much change to the current system, many legislators view the LTCSA as a prelude to the LTCI (Interview with legislator, Nov. 2014). Thus, in addition to the Ministry of Health and Welfare’s proposal, legislators from both parties have proposed 17 different versions. Most of the debates have been about whether or not to include the issue of migrant care workers in the act, as well as the financial sources involved (either from the LTCI or the tax-based system). Most importantly, the LTCI proposal was blocked by civil society and political party actors that are deeply integrated in the political process. In other words, pre-existing social policies have fostered strong policy advocacy communities that have created path dependency and resisted policy changes. This point will be clearer in the next section where I discuss the significance of political alliances between political parties, social organizations, and interest groups.
Civil Society Mobilization
Through the years, the civil societies in Taiwan have cultivated strong networks to influence the government policy regarding eldercare. Three major social group coalitions are involved in long-term care policies: Universal Care Policy Alliance, Long-Term Care Monitoring Alliance (LTCMA), and Long-Term Care Advocacy Alliance (LTCAA). Among the three coalitions, Universal Care Policy Alliance, led by Professor Liu Yu-Hsiu, has members mostly from women’s organizations and feminist groups. Universal Care Policy Alliance engages in both childcare and eldercare policy debates. Their policy agenda is to increase public provisions for childcare and eldercare and to increase female employment. In comparison, LTCMA and LTCAA are two social group alliances dedicated to advocating for long-term care policies. Both alliances have been formed primarily in response to the government’s LTCSA and the LTCI, with the intention to be involved in the policy debates.
Created in October 2010, LTCMA was initiated by the Taiwanese Association of Family Caregivers, the Taiwan International Workers’ Association (TIWA), and the Awakening Foundation, with 26 other member-social organizations and 10 academic scholars (Interview with NGO, Dec. 2014). On the other hand, LTCAA was established in March 2011, mainly led by the Federation for the Welfare of the Elderly, the League for Persons with Disabilities, and Parents’ Association for Persons with Intellectual Disabilities, with more than 350 social groups (Interview with NGO, Nov. 2014).
Although the memberships of these two alliances sometimes overlap, their significant difference is that LTCAA focuses on the interests of care recipients (such as seniors and people with disabilities), whereas LTCMA emphasizes the benefits for care providers (such as family caregivers and migrant care workers) and the minorities among the care recipients (aboriginal groups and Lesbian, Gay, Bisexual, Transgender, Queer communities). This difference in standpoint results in a major policy divergence on the issue of migrant care workers (Wang and Chen, 2017).
As an alliance of care providers, LTCMA actively advocates for the improvement of the working conditions of migrant care workers by integrating them into the public long-term care system. It proposes the gradual switch from the individual household, live-in employment to the institutional employment of migrant care workers. The change in employment types does not only reduce the possibilities for household abuses (including labor and sexual abuses) but, it also allows migrant care workers to undergo institutional on-the-job training. With institutional employment, migrant care workers can be protected under the Labor Standard Act, similar to local care workers. At the same time, LTCMA argues that it could increase job opportunities for local Taiwanese care workers to become supervisors and educators of migrant care workers (Interview with NGO, Jan. 2015).
On the opposite side, LTCAA (the alliance of care recipients) prefers to maintain the existing household, live-in employment because it is still necessary for some patients with serious disabilities. One of the major conflicts between the two alliances is LTCAA’s concern that once migrant care workers are granted more rights and labor mobility to switch between employers or transfer to home care institutions, patients with severe disabilities and the elderly would become the least favorite and the most undesirable cases for care workers. Instead of changing forms of employment, LTCAA proposes increasing migrant care workers’ pre-job training (such as language and skill training) and raising their monthly salary. Eventually, through market competition, LTCAA contends that people would come to prefer local workers and reduce their reliance on migrant care workers (Interview with NGO, Feb. 2015).
The confrontations between care recipients and care providers have been related to the power battle of political lobbying during the policy debates on the LTCI. LTCAA is politically stronger than LTCMA because LTCAA is organized around social groups, which have developed deep connections with the DPP and its legislators. Initially a grassroots social movement for democratization, the DPP (also known as tangwai or outside the party) has been closely connected to social groups and organizations. Many grassroots organizations, such as human rights organizations, labor unions, and environmental movements, strongly identify with the DPP as opposed to the KMT, which has been the ruling party since the authoritarian period. Because of the DPP’s political opposition to the authoritarian regime, the DPP has developed close connections with many social organizations by organizing political protests, supporting one another in rallies, and attending press conferences together.
After democratization, the DPP started to recruit scholars and experts from social organizations to campaign against the KMT, which had formed groups of bureaucratic and policy experts during its years of governing. In the 2004 election, the DPP directly nominated representatives from social organizations as legislators-at-large. For example, Wang Jung-Chang from the League for Persons with Disabilities was elected in the legislature as the first legislator-at-large, representing social welfare organizations and exercising direct influence on policy proposals and political debates. Similarly, Chen Chieh-ju from the League for Persons with Disabilities and the Parents’ Association for Persons with Intellectual Disabilities was elected in 2008 and 2012. Wu Yu-Qing from the Federation for the Welfare of the Elderly was elected in 2016, along with Wang Jung-Chang, who was re-elected.
As these social organizations are integrated into the DPP, they have been transformed from social organizations to institutionalized interest groups with direct influence on policy proposals and political negotiations. The role of social welfare organizations has been changed from consultative committees to direct policy makers that could propose policy drafts and block unfavorable bills. These are the social organizations that have formed LTCAA to promote the interests of care recipients.
In contrast, LTCMA is organized around social groups with fewer political ties and that are sometimes excluded from political negotiations. Frank Tsen-Yung Wang, the former president of the Taiwan Association of Family Caregivers, admits that LTCMA is primarily organized by previously marginalized or excluded social groups. For its part, TIWA is a more grassroots organization that has organized bi-annual migrant workers’ protests since 2003. The Taiwan Association of Family Caregivers has also been excluded from most of the policy committees involved in long-term care (Wang and Chen, 2017).
In sum, since the Taiwan government introduced the migrant care worker programs in 1992, the social welfare organizations have been divided into two different and sometimes conflicting groups: care providers and care recipients. While family caregivers and migrant worker organizations represent the perspective of care providers, social organizations of the elderly and people with disabilities represent the interests of care recipients. Through the process of democratization, the DPP has developed closer ties with the social organizations representing care recipients, who are also among the disadvantaged groups in society (the elderly and people with disabilities). This selective recruitment and integration between social welfare organizations and political parties had (and still has) political impacts, especially on the legislation regarding migrant care workers. This issue would be more evident if the process of political lobbying for the Household Service Act is traced.
Example of the Household Service Act
On February 8, 2003, Liu Shia, a well-known Taiwanese writer with disabilities, who was also the National Policy Consultant for President Chen Shia-Bien, died after being attacked by her Indonesian caregiver, who was later diagnosed with a psychological disorder. Many activists perceived the accident as the result of unreasonable working conditions for live-in migrant care workers and demanded that migrant care workers be included in the Labor Standard Act. In December 2003, migrant worker organizations organized the first bi-annual migrant worker rally and protest, under the theme of protecting basic labor rights of migrant care workers. The Council of Labor contended that it would be difficult to implement regulations in private households and suggested drafting a separate set of regulations for domestic care workers, which would apply to both local and migrant care workers alike. Therefore, migrant worker organizations initiated the Promoting Alliance of Household Service Act (PAHSA) to push for regulations of domestic care work (Interview with NGO, Nov. 2014).
In 2004, the PAHSA drafted the worker’s version of the Household Service Act to further regulate household employment. At the same time, they started to unite with other social organizations and lobbied legislators to propose their drafted act for congressional review. Initially, the PAHSA persuaded legislators across party lines to support their policy draft. Legislators Shyu Jong-Shyoung, Joanna C. Lei from KMT, Tsai Ing-wen from DPP, and Ho Min-Hao from the Taiwan Solidarity Union (pro-independence party) all agreed to propose the policy draft to the legislature for the first review (Interview with NGO, Nov. 2014).
However, the DPP’s legislator-at-large Wang Jung-Chang, who was also the representative of the League for Persons with Disabilities, refused to sign the draft and started to mobilize social organizations to pressure the legislators to drop the policy proposal (Interview with legislator, Dec. 2014). For the social organizations of the elderly and people with disabilities, more legal protection for migrant care workers would mean increased costs incurred by employers and families of care recipients. Many disadvantaged families would be unable to afford the employment of migrant care workers once the costs increase. The general regulations would also be difficult to apply to patients with different levels of disabilities. For example, some patients with serious disabilities require extra care every two to three hours during the night. It would be difficult to find an alternative if the law stipulates an eight-hour rest for live-in care workers, especially when the government’s respite services are not fully developed and exclude families that have already hired migrant care workers.
Additionally, the League for Persons with Disabilities, the Federation for the Welfare of the Elderly, and the Parents’ Association for Persons with Intellectual Disabilities managed to form policy alliances. These group alliances always support one another on policy agendas and lobby the legislators together. As discussed earlier, these social groups have also built a strong relationship with the DPP, and the deputy chair of the League for Persons with Disabilities, Wang Yu-Ling, was recruited by the Council of Labor as chief of the office in 2000. Therefore, unsurprisingly, the chairman of the Council of Labor (under the DPP government), Chen Chu, directly opposed the PAHSA’s policy proposal. At the same time, Wang Jung-Chang, the DPP legislator-at-large and a representative of the League for Persons with Disabilities, directly blocked this unfavorable policy proposal at the legislature. In contrast, migrant workers’ organizations have always been excluded from such policy alliances and were unable to ally with local care workers. Therefore, the PAHSA had a hard time drawing support from other social groups to push for legislation. As a result, the PAHSA’s version failed to pass the congressional review.
In sum, since 1992, the implementation of migrant care worker policies has created strong policy advocacy communities among care recipients. At the same time, these advocacy communities have been able to unite their connections with the DPP, especially after this party was elected in 2000. Collectively, they have formed a strong political alliance to resist policy changes, which has created a strong path dependency for the migrant care worker policies in Taiwan. Therefore, unless the government provides a feasible alternative (e.g., public care service) to the model of the family care/migrant-in-the-family care, it will be difficult for migrant worker organizations to advocate for the improvement of legal protection for migrant care workers.
Conclusion
The shift to a post-industrial and service-based economy and the changes related to family and gender relationship have all contributed to increasing demands for outsourced care. The lack of social care services has intensified the care responsibilities of individual families in Taiwan. In response to the rapidly aging population, Taiwanese families have turned to the market options and pushed for the employment of low-wage migrant care workers. The Taiwanese government has quickly responded by opening the immigration channel for migrant care workers as a means to push local women into the labor force. By allowing highly educated women to outsource care to migrant care workers, the Taiwanese government has sought to increase female labor participation without increasing its expenses for social care service.
In the beginning, the Taiwanese government recruited migrant care workers to provide both childcare (under the foreign domestic helper category) and long-term care for the elderly and people with disabilities (under the live-in caregiver category). However, local Taiwanese middle-aged women who worked in childcare as their part-time employment quickly pushed back and lobbied for the termination of the foreign domestic helper program. As a result, the Council of Labor imposed more restrictive requirements and a strict quota control on the foreign domestic helper program (for childcare). On the other hand, live-in care workers who provide 24-hour intensive care services have not faced much local opposition. Through the years, the Taiwanese government has relaxed the application requirements to make it easier for seniors and people with disabilities to hire live-in caregivers.
As Wong (2004) points out, East Asian social welfare policy reforms are deeply motivated by political factors. The political debates around migrant care worker policies are deeply embedded in the competition on political alliances between political parties and social organizations. Since the introduction of the live-in caregiver program in 1992, two distinct groups have represented different interests among social welfare organizations—care providers (e.g., family caregivers and migrant care workers) versus care recipients (e.g., seniors and people with disabilities). The social organizations representing the interests of the care recipients have been able to form strong political alliances with the DPP and among themselves. They have actively utilized their political ties with the DPP so that one of their representatives would be elected as legislator-at-large. Through strong lobbying and exerting pressure in the legislature, they have effectively dominated the political debates regarding the long-term care system and the issues concerning migrant care workers.
On the contrary, social groups representing the interests of care providers, especially family caregivers and migrant care workers, have constantly been excluded from such policy alliances and political dialogues, as shown in the example of the Household Service Act. It was not until 2011 that they started to form policy alliances, such as LTCMA, to collectively participate in the policy debates. The pre-existing social policies have facilitated the formation of strong policy advocacy communities among care recipients, which have created path dependency and resisted policy changes, such as improving the legal protection of live-in caregivers and implementing the LTCI. These strong policy advocacy communities among care recipients have effectively blocked the Household Service Act since 2003 and prolonged the discussion on the LTCI.
In the current debate regarding the introduction of the LTCI, Taiwan’s policy advocacy communities among care recipients continue to reject the government’s proposal despite the bureaucrats’ strong preference for such a policy. Without the development of social care services, Taiwan has heavily relied on migrant care workers to maintain its strong familialistic care model. If the development of social care systems remains limited, Taiwanese families with long-term care needs have few options but to increase their reliance on migrant live-in caregivers. This way, the policy advocacy communities among care recipients will remain robust and powerful, making it impossible to improve the working conditions and the labor protection of migrant care workers in Taiwan.
With its close examination of Taiwan’s live-in caregiver program, this article has argued that the pre-existing policies have created strong policy networks around the issues of migrant care workers and have made policy reforms difficult. The alliances between the progressive political party (DPP) and the care recipients’ social organizations (LTCAA) have been influential in the policy debates about long-term care service and have resisted the implementation of the LTCI. As the rapidly aging population becomes the main social issue in Taiwan, it becomes increasingly challenging to maintain the heavy reliance on migrant labor to provide long-term care services in the future. Therefore, how to introduce a stable long-term care system and integrate the existing migrant care labor into such a system will be among the most serious challenges to long-term care in Taiwan.
Footnotes
Acknowledgements
I would like to thank the editors of this special issue, Jennifer Chun and Heidi Gottfried, for their useful comments that have helped to improve the quality of this article. I also gratefully thank Ito Peng for her comments and support in the writing of this article, and Pei-Chia Lan for reading an earlier version and providing valuable feedback.
Declaration of Conflicting Interest
The author declares that there is no conflict of interest.
Funding
This work was supported by Doctoral Associate Programme at the Centre for Global Social Policy, University of Toronto, funded by the Social Science and Humanities Research Council of Canada, Partnership Grant on Gender, Migration, and the Work of Care (File No. 895-2012-1021), Ito Peng, PI. I also gratefully acknowledge the support of Chris Matthews International Graduate Student Scholarship and the School of Graduate Studies Research Travel Grant at the University of Toronto for my field research.